1. A model for implementing health outcomes

2. The importance of measuring health outcomes
Measuring, reporting, and comparing outcomes is perhaps the most important step toward unlocking rapid outcome improvement and making good choices about reducing costs (Porter, 2010)
Measuring the quality of people’s health and the care they receive is critical to improving performance of the health care system and patients’ health outcomes (Institute of Medicine, 2015).
We have a vast amount of ‘outputs’ but little that indicates the outcome/value to the service user of intervention
Too often we use the data that we have instead of the data we need to measure quality
In the face of technical difficulties and the cost of collecting health outcomes data from patients directly, many "outcome measures" actually use processes of care or use of services as "proxies" for patient's health states. For example, hospital readmission rate is sometimes referred to as an outcome measure (NQMC, 2015)

3. The importance of measuring health outcomes
Are an essential part of measuring quality along a care pathway
Are part of a commitment to outcomes based contracting and delivering value-based care
Support service user involvement in designing their own care
Drives service improvements

4. The importance of measuring health outcomes
Currently most quality metrics measure inputs or process rather than outcome
Health Outcomes Measures can:
Complement efficiency data
Track changes over time
Show differences in outcomes between clinical services with similar case mix (benchmarking)
Compare outcomes of treatment and care from different perspectives - e.g. clinical staff and patient

5. What are Health Outcomes?
Health Outcomes Measures record changes in health status, usually due to an intervention
Can be Clinician Reported (CROMs) or self-reported (PROMs)
Examples of Patient Reported Outcomes include:
Symptom measures (e.g. PHQ9, GAD7)
Quality of Life Measures (e.g. EQ5D, SF-12, ReQOL)
Function measures (e.g. WHO-DAS, Self-Care Index, TOMS)
Experience Measures (e.g. Friends and Family, CSQ, PEQ)

6. Current national situation
There is currently no standard approach and very few mandated health outcome measures
DoH is supporting development of ReQOL (a quality of life measure for mental health) in conjunction with Sheffield University
NHS England is developing is supporting development work on Health Outcome Measure “standard sets” through ICHOM

7. The NHS England Outcomes Framework

8. Can we adopt a single Health Outcome?
The range of services provided by South West Yorkshire Trust and the needs of our service users are so diverse, it is unlikely one single outcome measure will sufficient to comprehensively measure all aspect of healthcare

9. A model for implementing health outcomes
Key principles:
Standardise outcomes across similar services
Minimise burden of collection (e.g. through increasing use of IT)
Quick and simple to complete
Used to guide or improve practice
3 levels of health outcomes:
Clinical Level
Service Level
Organisational Level

10. Hierarchy of Outcomes Clinician (micro) Service (meso) Organisation
(macro)
Clinicians choose the appropriate outcomes and engage with service users to monitor and improve interventions
Where services are sufficiently similar they should be using the same outcome to allow benchmarking and identify variations
High level outcomes (probably a Quality of Life measure) to understand how service are “enabling service users to live well in their community”

11. Hierarchy of Outcomes Clinician (micro) Service (meso) Organisation
(macro)
Clinicians choose the appropriate outcomes and engage with service users to monitor and improve interventions
What is currently being used in services?
PHQ-9 / GAD-7
TOMS
CORE
SWEMWEBS
DIALOG
QUALIDEM
Current View
Other?
What are the options?
ReQOL?
EQ5D?
WHO DAS?
ExQOL?

12. Aims of the Health Outcomes group
Create a framework and establish conditions that will enable clinicians and service users to be able to record outcomes
Support implementation of outcome measures
Deploy measures of quality and value in order to link measurement to improvement

13. Action Plan
To identify local good practice – particularly in making use of outcomes
Work with clinicians, service users and commissioners to identify appropriate outcome measures and methods of delivery
Identify training and infrastructure requirements (including IT)
To facilitate clinicians and clinical leads to use the information to improve services

14. What do we need at an Executive level?
Commitment from the organisation
Investment of time and resources to agree outcome measures, support training and establish infrastructure

15. In conclusion
Measuring health outcomes is an essential part of quality and efficiency improvement and support transformation
It is unlikely that we will be able to identify a single outcome measure suitable for all populations or conditions
We are unlikely to receive national guidance in the near future.
We should be proactive and agree appropriate outcome measures as soon as possible and an approach to embedding them into routine clinical practice with least burden on clinicians and services

16. Process Indicators
Process indicators access the activities carried out by healthcare professionals to deliver services
Can be used to compare performance between providers
Examples include:
Preventative screening numbers
Waiting times for treatment
Patients seen within a defined time period

17. Outcome Indicators
Outcome indicators reflect the end result of health care
Can be useful in quality improvement programs, by pointing out the areas in which intervention could improve care
Examples include:
population outcomes - e.g. cancer mortality, hospital admission rates
clinical care outcomes – e.g. readmission rates
adverse events – e.g., hospital-acquired infections
patient experience of care
patient health status